The study, which appeared in the September issue of Pediatric Neurology, offers data that compared inpatient (treating and staying in the hospital) and outpatient (treating and then returning home) treatments using a ketogenic diet. The researchers said the benefits of outpatient treatment include improved acceptability and ability to maintain and comply with the diet. It also avoids the expense, inconvenience and potential low blood sugar associated with starvation during inpatient initiation. However, the intense educational process that inpatients receive could be preferable for some families and centers.
"Our study shows that it's possible to begin the diet safely as an outpatient and maintain it without restricting fluids as done in other centers," says Jeffrey Buchhalter, M.D., of the Pediatric Epilepsy Program in the Department of Neurology at Mayo Clinic and the senior author of the study. "For parents with children who have epilepsy, it means potentially fewer days of lost work while the diet is initiated and more comfort for their child. However, we do recommend that these findings need to be confirmed in a prospective study."
The Mayo Clinic authors of the study say further study is needed for more definitive answers about the best conditions for implementing and maintaining of the ketogenic diet.
Different diets have been popular in the treatment of epilepsy since ancient times. In the 5th century B.C., Hippocrates reports about a man suffering from epilepsy completely cured by abstinence from food and drink. The ketogenic diet, which is very high in fats and low in carbohydrates, was first developed almost 80 years ago. It makes the body burn fat for energy instead of glucose. The diet mimics the effects of starvation. When carefully monitored by a medical team familiar with its use, the diet helps two out of three epileptic children and may prevent seizures in one out of three, according to the Epilepsy Foundation. The diet has to be rigidly controlled. Any deviation can produce a seizure if the patient is thrown out of ketosis, a presence in the blood of abnormally high levels of acidic substances.
In the study, Mayo Clinic researchers used the Rochester Epidemiology Project medical records-linkage system to locate all diagnoses involving the ketogenic diet from 1963-1975. The system index allows the identification of all medical visits of residents of Olmsted County, Minn., including inpatient, outpatient and emergency department evaluations since 1935. In the study, records were reviewed of 37 patients who underwent the ketogenic diet as outpatients and 17 as inpatients.
There was no evidence that inpatient initiation of the ketogenic diet was superior to outpatient initiation with regard to long-term seizure control or mental improvement. This improvement rate was similar to the range of other reported studies.
In the Mayo Clinic study, there were no statistical differences in outcome between the groups started as inpatients and outpatients.
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Journal
Pediatric Neurology